AccountId: 011433970860
ContactId: e34d2cca-938a-41ae-aee5-c36be4d8513d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 138600 ms
Total Talk Time (AGENT): 66272 ms
Total Talk Time (CUSTOMER): 66577 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/e34d2cca-938a-41ae-aee5-c36be4d8513d_20250228T23:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Pearlman Clinic, um, at the design location. I'm calling just, just to see if, um, a patient that came in office has active, um, coverage and if they're in network with our medical group.
[AGENT][NEUTRAL] Sure, I can see if that policy is active and we will see what kind of policy that is [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, give me one second, let me pull that up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's gonna be 858.
[CUSTOMER][NEUTRAL] 864.
[CUSTOMER][NEUTRAL] 9800.
[AGENT][NEUTRAL] Thank you and do you have the policy number?
[CUSTOMER][NEUTRAL] I believe I do. Let me see, yeah, I have it, the policy slash certification number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gonna be 02595600.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's first name [PII], last name [PII], date of birth [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII] and so this policy, it is a limited indemnity medical plan, so it's not affiliated with any sort of network. Um, there's no copays, no deductibles, um, no authorization required it pays a specific dollar amount per covered procedure or office visit. You would just file those claims directly to us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got you, thank you so much and I'm sorry if this is like a dumb question, but uh we just need to know if it's a PPO or HMO plan, but it seems like it's not HMO then if um it's all claims submitted.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, correct, um, again it just pays that specific dollar amount, um, for covered procedure or office visit.
[CUSTOMER][POSITIVE] I see. OK, thank you so much and that's all I need to know.
[AGENT][NEUTRAL] Not a dumb question. It's not very, it's a bit different from traditional medical. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah it's a little I mean if I just gave you, I mean I'm sure we take PPO insurances so we I can already see that they're pretty much in network so um that's all good. I'll just go ahead and process it on my end.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK sounds good you're very welcome you too have a good weekend bye bye.
[CUSTOMER][POSITIVE] OK, thank you so much have a good one thank you you too bye bye.